Ten-year incidence and treatment outcomes of closed degloving injuries (Morel-Lavallee lesions) in a level 1 trauma centre.

INTRODUCTION: Morel-Lavallée lesions (MLL), also referred to as closed degloving injuries, result from traumatic shearing forces with separation of the subcutaneous fat from the underlying fascia. The aim of this study was to determine the incidence and treatment of MLLs at a level 1 trauma centre. METHODS: Single-centre retrospective cross-sectional study of consecutive patients with an imaging diagnosis of a Morel-Lavallee lesion from 1/1/2010-31/12/2019. Demographic data, mechanism of injury, volume of lesion, management and outcome data were collated. RESULTS: Sixty-six MLLs were identified in 63 patients (64% Male) with a median age of 49.5 years (19-94 years). Mechanism of injury were road traffic accidents in the majority (66%). Median injury severity score (ISS) was 17 (range 1-33). Patients on oral anti-coagulants had significantly larger lesions (181.9 cc v 445.5 cc, P = 0.044). The most common lesion location was the thigh (60.5%). Patients that underwent imaging within 72 h of injury had significantly larger lesions than those imaged more than 72 h after the inciting trauma (65 cc v 167 cc, P < 0.05). Management data were documented in 59% of lesions (39/66) in which 66.6% (n = 26) had invasive treatment. In the 31 patients where follow-up was available, 64.5% (n = 20) were persistent but decreasing in size. There was no significant difference in follow-up size for those who had invasive compared to conservative treatment (P = 0.3). CONCLUSION: The diagnosis of MLL should be considered for soft-tissue swelling in the context of shearing trauma. A variety of management options have been employed, with good overall outcomes.

Panarteritis nudosa cutánea: no todo es eritema nudoso / Polyarteritis nodosa: not all is erythema nodosum

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MRI of the Morel-Lavallée lesion - a case series.

INTRODUCTION: The aim of the study was to review the appearances of Morel-Lavallée (ML) lesions on magnetic resonance imaging (MRI). PATIENTS AND METHODS: 14 patients diagnosed with the ML lesion on MRI were analysed retrospectively (mean age = 35 years). Mechanism of injury, time frame from injury to MRI, location, shape, T1 and proton-density fat-suppression (PDFS) signal intensity (SI), presence of a (pseudo)capsule, septations or nodules within the collection, mass effect and fluid-fluid levels were analyzed. The Mellado and Bencardino classification was utilized to classify the lesions. RESULTS: In most cases, mechanism of injury was distortion. Mean time frame between the injury and MRI was 17 days. Lesions were located around the knee in 9 patients and in the peritrochanteric region in 5 patients. Collections were fusiform in 12 patients and oval in 2 patients. 9 collections were T1 hypointense and PDFS hyperintense. 4 collections had intermediate T1 and high PDFS SI. 1 collection had intermediate T1 and PDFS SI. (Pseudo)capsule was noted in 3 cases. Septations or nodules were found in 4 cases. According to the Mellado and Bencardino, collections were classified as seroma (type 1) in 9, subacute hematoma (type 2) in 1 and chronic organizing hematoma (type 3) in 4 cases. CONCLUSIONS: Characteristic features of ML lesion include a fusiform fluid collection between the subcutaneous fat and the underlying fascia after shearing injury. Six types can be differentiated on MRI, with the seroma, the subacute hematoma and the chronic organizing hematoma being the commonest.

Multidisciplinary treatment of a complicated crural degloving injury in a diabetic patient.

Diabetes is a common disease that potentially interferes with healing processes after lower limb trauma. In our presented case a trimalleolar ankle fracture with undiscovered serious soft-tissue injuries resulted in chronic soft-tissue complications in a diabetic patient, requiring three and a half months of hospitalization in a higher level center and the application of state-of-the-art wound treatment, including vacuum-assisted closure therapy, Integra bioengineered skin substitute, split-thickness skin-grafting, and methods enhancing wound healing, such as polarized light therapy and transdermal CO2 delivery. The presented case emphasizes the importance of soft-tissue care and multidisciplinary approach in diabetic trauma patients with poor compliance.

The First Reported Case of Morel-Lavallée Lesion and Traumatic Abdominal Wall Hernia: A Case Report and Review of the Literature.

BACKGROUND First described in 1863 by French surgeon Victor-Auguste-François Morel-Lavallee, the Morel-Lavallee lesion (MLL) is a closed traumatic soft-tissue degloving injury. These lesions most commonly occur following motor vehicle collisions (MVCs). The pathophysiology stems from a shearing force that causes separation of the soft tissue from the fascia underneath, which disrupts the vasculature and lymphatic vessels that perforate between the tissue layers. Timely diagnosis and treatment are imperative, as a delayed diagnosis can lead to complications. However, at present there is no universally accepted treatment algorithm. CASE REPORT A 60-year-old morbidly obese woman presented after being involved in an MVC. She complained of abdominal tenderness in the right lower quadrant, with no evidence of peritonitis. Cross-sectional imaging revealed hemoperitoneum and a traumatic posterior abdominal wall/lumbar hernia on the right, with multiple contusions in the subcutaneous abdomen. The patient was taken to the operating room and underwent an exploratory laparotomy that revealed a large abdominal Morel-Lavallee lesion (MLL) along with a traumatic abdominal wall hernia (TAWH). There was also a mesenteric avulsion injury with an associated ileocecal injury. The patient underwent resection of the involved bowel, with primary anastomosis, debridement of the abdominal wall degloving injury, and expectant management for the hernia defect. She recovered from the injuries and was doing well when followed up in the clinic, with follow-up to repair the hernia in the near future. CONCLUSIONS More research is needed to provide surgeons with evidence-based standardized therapies for dealing with these rare pathologies to ensure optimal patient outcomes.

Medico-legal considerations for Morel-Lavallée lesions.

The Morel-Lavallée lesion is an infrequent traumatic lesion that the forensic physician may need to evaluate during examination of a victim. Using a review of the literature and an illustrative case, the objective of this paper is to discuss the medico-legal issues (accountability, functional recovery and healing times, and aftermath) associated with Morel-Lavallée lesions. We describe the case of a 24-year-old motorcycle driver who was hit by a car. Clinically, the right lumbar region had a large 16 × 15 cm ecchymosis with subcutaneous fluid swelling found by palpation. A body scan revealed a Morel-Lavallée lesion among other lesions. On day 7, its thickness was decreased by half. Morel-Lavallée lesions are specifically induced by shearing force with moderate-to-high kinetics in an anatomical area with an underlying fascia. The associated functional disability is globally moderate, but a large lesion or recurrences can extend the time needed to recover. Apart from some exceptions, care without any delay in diagnosis and treatment allows evolution of the lesion without functional consequences, but these lesions are frequently unnoticed in the initial phase.

Posttraumatic hip bulging mimicking an abscess in a patient with hip prosthesis: the role of ultrasonography.

A 48-yr old female patient, with stage 4 rheumatoid arthritis, who had undergone multiple joint prostheses including four arthroplasties of the left hip, presented for a sudden-onset large bulge on the left thigh, after a minor local injury. Orthopedic examination and radiography excluded fractures. Ultrasonography revealed a large mixed hypo- and hyperechoic collection,with no Doppler signal, but with comet tail artifacts. Repeated cultures from the collection were negative. Fluid analysis revealed increased quantities of titanium and cobalt. The sudden-onset deformity and fluid collection were in favor of a shear lesion (Morel-Lavallée). The new collection communicated with a previously asymptomatic periprosthetic aseptic abscess, mimicking an infection. To our knowledge, Morel-Lavallée shear lesions have not been described in patients with hip prostheses. Their presence may add to the difficulties of ruling out silent infections in such patients. Ultrasonography is a very effective method for the diagnosis and follow-up of collections in this setting.

Lesión de Morel-Lavallée: diagnóstico y tratamiento con técnicas de imagen / Morel-Lavallée lesion: diagnosis and treatment with imaging techniques

Objetivo: Revisar las características de las lesiones de Morel-Lavallée y valorar su tratamiento. Material y métodos: Hemos revisado de forma retrospectiva 17 pacientes diagnosticados de lesión de Morel-Lavallée en dos servicios diferentes: 11 hombres y 6 mujeres, edad media 56,1 años, rango de edad 25-81 años. En todos se hizo un estudio con ecografía, en cinco se realizó tomografía computarizada y en nueve resonancia magnética. Trece fueron tratados de forma percutánea mediante aspiración con aguja fina o drenaje con catéter de 6-8 F, o con ambos procedimientos. Dos pacientes requirieron esclerosis percutánea con doxiciclina. Resultados: Todos los pacientes respondieron de forma adecuada al tratamiento percutáneo, aunque en cuatro hubo que repetir el procedimiento. Conclusiones: El radiólogo debe estar familiarizado con esta patología cuyo tratamiento percutáneo, cuando no está asociada a otras afecciones, puede realizarse con éxito en la sala de ecografía

Objectives: We aim to review the characteristics of Morel-Lavallée lesions and to evaluate their treatment. Material and methods: We retrospectively reviewed 17 patients (11 men and 6 women; mean age, 56.1 years, range 25-81 years) diagnosed with Morel-Lavallée lesions in two different departments. All patients underwent ultrasonography, 5 underwent computed tomography, and 9 underwent magnetic resonance imaging. Percutaneous treatment with fine-needle aspiration and/or drainage with a 6F-8F catheter was performed in 13 patients. Two patients required percutaneous sclerosis with doxycycline. Results: All patients responded adequately to percutaneous treatment, although it was necessary to repeat the procedure in 4 patients. Conclusions: Radiologists need to be familiar with this lesion that can be treated percutaneously in the ultrasonography suite when it is not associated with other entities

Arteriography and Histopathology of Vascular Beds in Traumatically Amputated Fingers.

BACKGROUND: The success of replantation following traumatic amputation is determined by the quality of the vascular anastomoses. The purpose of this study was to assess the vascularity of injured arteries from traumatically amputated digits using arteriographic and histopathological analysis. METHODS: 25 amputated digits were included in the study. Crush and avulsion injuries were evaluated according to the Venkatramani classification. The amputated arteries were dissected under a microscope, and the arterial route determined with a transducer. Arteriography using fluoroscopy was evaluated by a radiologist. The area thought to be damaged was dissected and 2-mm slices taken for histopathological examination, and scored using the parameters of fibrin accumulation, oedema, separation, and bleeding. RESULTS: Arterial flow was observed in 6 of 7 in the avulsion group. In the crush group, arterial flow was observed in 11 of 16 cases. On histopathological examination in all cases there were 2 or more findings of either oedema, fibrin formation, bleeding or hernia. These findings were more common in the crush group then the avulsion group. CONCLUSIONS: The intravascular introduction of radio contrast agents to amputated digit prior to replantation may give further information particularly in avulsion amputations.

A Patient With Severe Lower Face Degloving Injury.

Avulsions of mandible are among the most devastating lesions observed in cranio-maxillofacial traumas. They present an important health problem because of the high risk of morbidity related to deformities that cause functional limitations and esthetic changes. The avulsions commonly result from high-energy effects, which cause complete or partial separation of the mandibular bone of the face. As a result of the intense aggression, the skin and subcutaneous tissues of the bone are usually removed, affecting muscles, fascia, blood vessels, and the surrounding nerves. This article aimed to present a case of partial avulsion of mandible caused by car accident. Here, we emphasize the importance of correctly performing patient stabilization and maintenance of the airways, damage control, and facial reconstruction. Finally, we proceeded with a literature review to discuss standard protocols and controversies in the treatment of these lesions.

Hidden degloving rotator cuff tears secondary to glenohumeral dislocation.

BACKGROUND: A rare form of rotator cuff tear (RCT) is observed secondary to glenohumeral dislocation, followed by immediate repositioning, as well as formation of scar tissue between tendons and tuberosities. Radiographic diagnosis of such "degloving" tears is problematic because they are obscured by scar tissue. We aimed to describe characteristics of degloving tears and report outcomes following their arthroscopic repair. METHODS: Among 67 patients who underwent arthroscopic repair of RCTs secondary to shoulder dislocation, we identified 8 patients (12%) (7 anterior dislocations and 1 posterior dislocation), aged 54.5 years (range, 38-61 years), with typical characteristics of degloving tears. Preoperative imaging revealed massive 2- or 3-tendon tears in all patients (6 with a ruptured or dislocated long head of the biceps), evaluated preoperatively and at greater than 2 years, using the absolute and age- and gender-adjusted Constant scores, Subjective Shoulder Value, and Simple Shoulder Test score. RESULTS: The absolute Constant score improved from 27 (range, 17-54) to 89 (range, 62-95). The age- and gender-adjusted Constant score improved from 31 (range, 24-57) to 97 (range, 83-100). The Simple Shoulder Test score improved from 2 (range, 0-4) to 12 (range, 9-12), while the Subjective Shoulder Value improved from 18 (range, 10-30) to 90 (range, 60-100). All patients were very satisfied (63%) or satisfied (37%). CONCLUSION: We have described a particular form of RCT secondary to glenohumeral dislocation, resulting in degloving of the rotator cuff, followed by repositioning of tendons. The formation of scar tissue can obscure tendon tears on ultrasound, in which case further imaging is recommended to ascertain the diagnosis and avoid therapeutic delays.

A Rare Presentation of a Morel-Lavallee Lesion of the Lower Leg Successfully Treated With Ultrasound-Guided Aspiration.

A Morel-Lavallee lesion (MLL) is a relatively rare condition that is caused by a traumatic shearing force. This force leads to a closed degloving injury of the subcutaneous tissue and fascia that creates a potential space that can fill with lymph, blood, and necrotic fat. The MLLs are traditionally seen after high impact trauma and typically located at the greater trochanter and pelvis, although recent reports have found them to be located at the knee, thigh, and lower leg. The MLLs typically present as swelling at the site of injury, which can be difficult to differentiate from several other diagnoses. This case report discusses an MLL in the lower extremity that occurred during a rugby game. A lack of familiarity with MLLs often leads to delayed diagnosis and treatment. The diagnosis was eventually made with an magnetic resonance imaging, and the lesion was successfully treated with ultrasound-guided aspiration and compression. The athlete was able to return to play without recurrence of the lesion.

Lesión de Morel-Lavallée: la importancia del diagnóstico precoz / Morel-Lavallée lesions the importance of early diagnosis

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Morel-Lavallee lesion in pediatric trauma.

Morel-Lavallee lesions (MLL) are closed degloving injuries that have been rarely described in the pediatric literature. These internal degloving injuries can have serious complications and long-term morbidity. Early diagnosis and intervention is imperative. We present the case of a 20-month-old with MLL of the thigh.

Morel-Lavallee Lesion in the Upper Extremity.

Background: The Morel-Lavallee lesion (MLL) is a closed internal degloving injury that results from shearing of the skin and subcutaneous tissue from the underlying fascia. Disruption of the perforating blood vessels and lymphatics results in a lesion filled with serosanguinous fluid and necrotized fat. MLLs are most commonly described in association with pelvic and lower extremity trauma, and there are limited reports of these lesions in other locations. Methods: This case report describes a 58-year-old male referred from his primary care physician with a soft tissue mass in the upper arm. Careful history discovered prior trauma with extensive bruising and MRI revealed a large encapsulated mass consistent with MLL. Results: An open debridement with excision of pseudocapsule was performed. Meticulous closure over a drain was performed and the patient healed without complication or recurrence. Intra-operative cultures were negative and pathology was consistent with MLL. Conclusion: MLL should always be considered in the setting of previous trauma regardless the location. In the chronic setting an open approach with excision of pseudocapsule can have an acceptable result.

Osteoarticular allograft reconstruction of post-traumatic defect of distal femur in a pediatric patient: A case report and literature review.

Successful results of osteoarticular allografts in reconstruction of periarticular bone defect after tumor resection encouraged its utilization in post-traumatic defects. Here we describe a case of post-traumatic skeletal defect in a 4 year-old girl treated with osteoarticular allograft reconstruction. Due to severity of the associated soft tissue injury and contamination at presentation staged treatment with antibiotic spacer followed by the reconstruction was carried out. At the end of one year the patient achieved 'Musculoskeletal tumor society' functional score of 27 points and radiographic score of 93%. Reconstruction immediately after healing of soft tissues prevented development of any varus or valgus deformity of the knee. Our case demonstrates utility of osteoarticular allograft in a pediatric post-traumatic skeletal defect.